Fever of Unknown Origin: Don't Forget Kala-Azar Even in Europe

We present the case of a 70-year-old male patient with fever of unknown origin after a long period of convalescence from a previous admission to a chronic care hospital. During the admission, multiple combinations of antibiotic and antifungal treatments were prescribed, but with persistent fever and, eventually, neutropenia (200 lymphocytes, 0 neutrophils). Given the suspicion of infection at bone marrow level, a biopsy was performed as was serology of Leishmania, both diagnostic determinations. Treatment with amphotericin B liposomal resulted in a good outcome.

Visceral leishmaniasis is a rare aetiology of neutropenia, which causes an important constitutional syndrome and long-standing fever.However, this pathology is endemic in areas of the Mediterranean Sea, which is well known for migratory flows.High clinical suspicion of leishmaniasis is necessary in patients with fever of long evolution, hepatomegaly or splenomegaly, fever and constitutional syndrome, and from endemic areas.